Anticonvulsants for neuropathic pain: gaps in the evidence.

OBJECTIVE: To summarize the available evidence on the use of anticonvulsant drugs for the treatment of various conditions of neuropathic pain. METHODS: This is a systematic review on quantity and quality of evidence for using anticonvulsants in the management of neuropathic pain. Medical Subject Heading terms searched were "anticonvulsants" and "pain." Data sources used were the Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, Medline 1966 to May 2006, Embase 1980 to May 2006, and CINAHL 1982 to May 2006. Additional studies were identified by hand searching the reference lists of retrieved papers and by autoalerts subsequent to May 2006. Randomized controlled trials, systematic reviews, and meta-analyses included. Non-English papers excluded. Evidence and evidence gaps with regard to specific conditions and drugs identified. RESULTS: Concise summary of all existing evidence or lack thereof was produced. A succinct table is presented of the efficacy of specific drugs for specific conditions and the nature and quality of evidence. The paper outlines the incidence of specific neuropathic pain conditions within various population groups and assesses the quantity of available evidence in regard to the frequency that those conditions are likely to occur. DISCUSSION: Gaps in the evidence are striking. Recommendations directly supported by the evidence by drug and by condition are made.

Pandora's electronic box: GPs reflect upon email communication with their patients.

BACKGROUND: Global access to information technology has increased dramatically in the past decade, with electronic health care changing medical practice. One example for general practitioners (GPs) is communication with patients via electronic mail (email). GPs face issues regarding e-communication with patients, including how and when it should it be used. OBJECTIVE: The study aims were to assess the extent that GPs communicate with patients by email and explore their attitudes to this mode of communication. METHODS: Design--telephone interview survey. Setting--primary care, largest urban and suburban area in New Zealand (NZ). Subjects--randomly selected GPs from the Auckland region. Main outcome measure--description of email use; analysis of issues by telephone survey. Data analysed using SPSS-12 and by thematic content analysis. RESULTS: At data saturation, 80 GPs had been interviewed. The majority (68%) had not used email with patients. Only 4% used it regularly. However, there was strong interest in this method. Perceived advantages were the ability to communicate at a distance and time convenient to both doctor and patient; communication where disability affected traditional methods; information-giving (for example, web links); passing on normal results. Identified problems involved inequity of access; linking of electronic data; security; unsuitability for some topics; medico-legal concerns; time; remuneration. CONCLUSION: Study sample closely mirrored current NZ GP population. Although few GPs emailed with patients, many might once barriers are addressed. GPs had a collective view of the appropriate boundaries for email communication, routine tasks and the transmission of information. GPs would encourage professional debate regarding guidelines for good practice, managing demand and remuneration.

GP discussion of prognosis with patients with severe chronic obstructive pulmonary disease: a qualitative study.

BACKGROUND: Recent research shows that health professionals do not communicate about prognosis with patients with chronic obstructive pulmonary disease (COPD) as openly as with patients who have cancer. AIM: To identify strategies that general practitioners (GPs) can use to facilitate discussion of prognosis with patients who have COPD. DESIGN OF STUDY: Telephone interviews of 15 GPs and five respiratory consultants on the topic of discussing prognosis with patients who have severe COPD. SETTING: Participating doctors worked in the Auckland region of New Zealand. METHOD: GPs and consultants were selected purposively to detect unique and shared patterns from diversity in how prognosis is discussed with patients with severe COPD. An interview guide was developed from a literature review and results of our earlier postal survey of GPs. Transcripts of audiotaped interviews were analysed independently and then together by three authors, using a general inductive approach. RESULTS: Seven strategies were identified that GPs had used or could use to facilitate discussion of prognosis with patients with COPD. These were: be aware of implications of diagnosis; use uncertainty to ease discussion; build relationship with patients; be caring and respectful; begin discussion early in disease course; identify and use opportunities to discuss prognosis; and work as a team. CONCLUSION: A number of suggested strategies can be used to facilitate discussion of prognosis with patients who have severe COPD.